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The UK Medical Licensing Assessment (UKMLA) is an exam that will officially be coming into effect for medical students graduating in 2025 and has been introduced as a pilot in the academic years prior. It was originally scheduled for 2024 but due to COVID-19, the GMC had to postpone preparations. I sat it this year as part of my medical school finals.
UK medical graduates from 2025 onwards will need to pass the UKMLA before joining the medical register. International medical graduates will be required to pass from early 2024 (it will replace the Professional and Linguistic Assessments Board test - PLAB). The UKMLA has been produced to make sure that UK medical graduates can demonstrate that they meet a common and consistent threshold for safe clinical practice.
What the assessment involves
It’s a 2-part assessment made up of an applied knowledge test and a clinical and professional skills assessment. Medical students will have to sit both parts on set dates chosen by their medical school.
1) The applied knowledge test (AKT)
x2 on-screen (computer) exams, run by each medical school, with 100 single best-answer questions each.
All UK medical schools + the Medical Schools Council will develop the AKT questions.
Universities will decide on exact dates for AKT to be taken.
Questions will be approved and quality assured by the GMC.
Will test students' ability to apply medical knowledge to different scenarios (again similar to the types of testing we have had throughout our clinical years medical school).
Find out more about the AKT in the GMC's joint statement with the Medical Schools Council.
Final year medical students will need to pass the AKT before they take their CPSA (new OSCE, see below).
2) The clinical and professional skills assessment (CPSA)
This is a practical assessment of clinical skills and professionalism, which each medical school will set and run. It will run in an OSCE (Objective Structured Clinical Examination) format and will be integrated into current processes.
The Prescribing Safety Assessment (PSA)
The Prescribing Safety Assessment (PSA) is a pass/fail assessment of the prescribing skills of final-year medical students and is based on the competencies identified by the General Medical Council outlined in Outcomes for graduates.
These competencies include writing new prescriptions, reviewing existing prescriptions, calculating drug doses, identifying and avoiding both adverse drug reactions and medication errors, and amending prescribing to suit individual patient circumstances.
Preparing for the UKMLA
The GMC says that our degree course is the best preparation for the UKMLA - and that we won’t need to learn anything beyond what's already covered in our medical school’s curriculum.
The MLA content map can be viewed here and shows the topics and areas that the assessments will cover.
It’s all based on the Outcomes for graduates, which sets out what newly qualified doctors from UK medical schools must know and be able to do. Every medical school already needs to make sure their graduates are meeting these outcomes – so hopefully, our medical schools are preparing us already!
How I studied for it and what I found different
I recently found out I passed my final exams (YAY) which included the x2 100 question AKT papers and a 16-station OSCE.
Key things about the UKMLA that I found different to my previous medical school exams:
The AKT was more comprehensive in its scope. It did not only ask your typical diagnosis and management questions, but most questions were either multi-step, requiring you to figure one thing out e.g. a diagnosis, then asking the best investigation or the underlying pathophysiology of the condition, OR expecting you to know the nitty-gritty details that would make you choose one answer over the other. I.e. they will present a LARGE list of results + patient vignette and if the 2 answers you've narrowed down are appendicitis vs ectopic, what key values in the long results list makes you choose one over the other?
Expect more data interpretation q's: LOTS of blood results + imaging, ECGs.
More q's regarding drug mechanisms of action and when we shouldn't be using drugs or changing them in specific situations like renal impairment - this came up A LOT.
Vague vignettes with multiple choice options that are difficult to differentiate unless you pick up on SPECIFICS in the question.
The OSCE did NOT change.
Overall: it is based on what most of us have been taught in medical school and still maps onto many of the resources we already use HOWEVER, if you want to score well, you will need to revisit your earlier years of medical school, especially your pharmacology, anatomy and pathophysiology.
Here's what I found the most useful when studying:
Passmedicine
Passmedicine still reigns supreme for me because it is probably the most vast question bank and covers ALL the relevant topics with updated NICE guidelines. It provides an excellent platform for honing your knowledge and testing your understanding of key concepts over time and the detailed explanations accompanying each question help reinforce learning and identify areas for improvement. I would be absorbing these explanations for the AKT because trust me, the nitty gritty stuff really does come up! And ALL of it is on Passmed in the high-yield textbook that we often skim over! Read those explanations to the end. Aim to finish the whole question bank. If you want to refresh your pre-clinical knowledge, consider purchasing the Years 1-3 questions - they are actually great for some quick recall.
MSCAA AKT Past Papers
The Medical Schools Council Assessment Alliance (MSCAA) provides past papers for the Applied Knowledge Test (AKT) component of the UKMLA exam. These papers offer valuable insight into the format and types of questions you can expect on the actual exam (some questions actually do pop up since the country is using one question bank now). Practicing with past papers will familiarise yourself with the question type and refine your exam technique, ultimately boosting your confidence on test day. Unfortunately, the questions are not as straightforward as Passmed, and doing the AKT past papers helped me shift gears and get better at pattern recognition for the real exam.
Quesmed
Quesmed is another valuable resource offering a wide range of practice questions for the UKMLA exam. Its user-friendly interface and customizable quizzes allow you to focus on specific areas of weakness or target particular topics for revision. Additionally, Quesmed tracks your progress over time, enabling you to monitor your performance and track your improvement as you study.
Anki
Anki can be hit or miss - I think it becomes too overwhelming for most of us and the interface is basic (so not the cutest to look at). HOWEVER, I think if you use Anki to drill into your head the questions you keep getting wrong and the really important drug mechanisms, contraindications and clinical anatomy - it can be a powerful memory aid.
Geeky Medics UKMLA Content Map
Geeky Medics offers a comprehensive content map specifically tailored to the UKMLA exam. This resource outlines the key topics and learning objectives required for the exam, providing a structured framework for your study plan. By following the content map, you can ensure that you cover all the essential material systematically, maximizing your chances of success on the exam.
And of course, Geeky Medics is the gold standard for OSCEs, forever and always!
In addition to these resources, it's essential to incorporate a variety of study strategies into your preparation routine. Allocate dedicated study time each day, set realistic goals, and utilise active learning techniques such as summarisation, self-testing, and teaching others.
Can I resit the UKMLA?
The UKMLA will be part of the requirements for our degree. If you fail it, just as if you fail any other degree requirement, you won’t graduate. In the same way, if you pass all components of the UKMLA but don't meet some of the other requirements set by your medical school for your degree, you won’t be able to graduate.
There will be chances to resit the AKT and CPSA (OSCE) but this will probably be determined by your respective medical school.
Foundation programme & ranking
The GMC admits that it will be possible to rank each student on the basis of their performance in the UKMLA, but it is unclear whether this information will be shared with medical schools or the public.
Introducing league tables of performance in the UKMLA could increase competitiveness between medical schools, and they might start marketing themselves as institutions that offer prospective students a higher chance of passing the UKMLA.
It is not currently confirmed that the UKMLA will be used to rank medical students. However, it is likely that since the UKMLA is replacing finals, the EPM or some sort of ranking system could make a return. However, at the moment, new graduates are currently RANDOMLY allocated their jobs across the country (unless they have applied for SFP or FP). See full blog post about this here.
Is the UKMLA going to be the UK version of the USMLE?
The UKMLA and the USMLE are medical licensing exams for the UK and the US respectively. Both work on a pass/fail basis (USMLE Step 1 is P/F, Step 2 and 3 are not).
The formats of UKMLA vs USMLE differ in various ways. The USMLE is made up of 3 steps (approximately £900 each) taken by both US and international medical graduates to practice Medicine in the US. The exam assesses your ability to apply medical knowledge as well as your patient-focused skills to ensure you are fit to practice safe and effective medical care. The UKMLA is a single assessment period at the end of medical school. Equivalency between the 2 cannot be drawn, however, the UK remains an accredited country by the ECFMG until its renewal due in Spring 2029 so this exam doesn't change much for us. Just make sure you pass it!
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